<br />
<form>
<table>
	<tr valign="top">
		<td colspan="3" align="center"><h2>Form Pendaftaran</h2></td>
	</tr>
	<tr>
		<td>Event</td><td>:</td><td><select name="event"><option value="ODE">ODE</option><option value="CEDP">CEDP</option></select></td>
	</tr>
	<tr valign="top">
		<td>Kota / <i>City</i></td><td>:</td><td><input name="city" /></td>
	</tr>
	<tr valign="top">
		<td>Nama / <i>Name</i></td><td>:</td><td><input name="name" /></td>
	</tr>
	<tr valign="top">
		<td>Asal Institusi / <i>Institution</i></td><td>:</td><td><input name="institution" /></td>
	</tr>
	<tr valign="top">
		<td>Email Pribadi / <i>Private Email</i></td><td>:</td><td><input name="email" /></td>
	</tr>
	<tr valign="top">
		<td>Telephone / <i>Phone</i></td><td>:</td><td><input name="phone" /></td>
	</tr>
	<tr valign="top">
		<td>Pilihan Kelas / <i>Choices of Topic</i></td><td>:</td>
		<td><select name="topic">
				<option value="A">Kelas / <i>Class</i> A</option>
				<option value="B">Kelas / <i>Class</i> B</option>
				<option value="C">Kelas / <i>Class</i> C</option>
			</select>
		</td>
	</tr>
	<tr valign="top">
		<td>Apabila ada informasi, silahkan menghubungi saya via <br /> <i>For any further information, please reach me via</i> </td><td>:</td>
		<td><select name="via"><option value="email">Email</option><option value="phone">Telepon / <i>Phone</i></option></select></td>
	</tr>
	<tr valign="top">
		<td>Mohon untuk memberi saya Handout dalam bahasa <br /> <i>Please give me handout in</i> </td><td>:</td>
		<td><select name="handout"><option value="Indonesia">Indonesia</option><option value="English">Inggris / English</option></select></td>
	</tr>
</table>
</form>